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Ankle Exam

Muscle Inspection

August 22nd, 2017

Muscle Wasting

  • Look For

  • Decreased mass of the muscles affecting the ankle. Note whether wasting is isolated to a single muscle or muscle group, isolated to the lower limb or generalised.
  • Causes of Muscle Wasting

  • Normal aging
  • Disuse
  • Malnutrition - poor diet, malabsorption, cancer
  • Denervation - trauma, ALS, Guillain-Barre Syndrome, neuropathy, polio
  • Muscular disorders - inflammatory myopathy, muscular dystrophies
  • Chronic disease - cancer, heart failure, COPD, infection, cirrhosis, kidney disease

Muscle Spasms

  • Look For

  • Spontaneous, uncontrollable contraction(s) of muscle. Note whether the spasm affects a single region, is generalised or affects the ipsilateral arm and leg.
  • Causes of Muscle Spasms

  • Exercise-induced spasm (cramping)
  • Dehydration
  • Electrolyte abnormalities - hyper/hyponatraemia
  • Hereditary dystonia - idiopathic, Huntington's, Wilson's
  • Acquired dystonia - brain damage, encephalitis, parkinsonism, brain tumour, stroke, drug-induced
  • Factitious dystonia


  • Look For

  • Visible, spontaneous localised muscle contraction and relaxation.
  • Causes of Fasciculations

  • Benign / normal
  • Lower motor neuron disorders - ALS, radiculopathy, peripheral neuropathy, entrapment, syringomyelia, Creutzfeldt-Jakob disease
  • Metabolic disorders - thyrotoxicosis, tetanus, anticholinesterase medications
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